Which model was the first to conceptualize the different factors that enter into health behaviors?

The Health Belief Model (HBM) is a tool that scientists use to try to predict health behaviors. It was originally developed in the 1950s and updated in the 1980s. The model is based on the theory that a person's willingness to change their health behaviors primarily comes from their health perceptions.

According to this model, your individual beliefs about health and health conditions play a role in determining your health-related behaviors. Key factors that affect your approach to health include:

• Any barriers you think might be standing in your way
• Exposure to information that prompts you to take action
• How much of a benefit you think you'll get from engaging in healthy behaviors
• How susceptible you think you are to illness
• What you think the consequences will be of becoming sick
• Your confidence in your ability to succeed

Health experts often look for ways that Health Belief Models can affect the actions people take, including behaviors that can have an impact on both individual and public health.

This article discusses how the Health Belief Model works, the different components of the model, and how this approach can be used to address health-related behaviors.

There are six main components of the Health Belief Model. Four of these were main tenets of the theory when it was first developed. Two were added in response to research on the model related to addiction.

The probability that a person will change their health behaviors to avoid a consequence depends on how serious they believe the consequences will be. For example:

• If you are young and in love, you are unlikely to avoid kissing your sweetheart on the mouth just because they have the sniffles and you might get their cold. On the other hand, you probably would stop kissing if it might give you a more serious illness.
• Similarly, people are less likely to consider condoms when they think STDs are a minor inconvenience. That's why receptiveness to messages about safe sex increased during the AIDS epidemic. The perceived severity increased enormously. 

The severity of an illness can have a major impact on health outcomes. However, a number of studies have shown that perceived risk of severity is actually the least powerful predictor of whether or not people will engage in preventive health behaviors.

People will not change their health behaviors unless they believe that they are at risk. For example:

• Individuals who do not think they will get the flu are less likely to get a yearly flu shot.
• People who think they are unlikely to get skin cancer are less likely to wear sunscreen or limit sun exposure.
• Those who do not think that they are at risk of acquiring HIV from unprotected intercourse are less likely to use a condom.
• Young people who don't think they're at risk of lung cancer are less likely to stop smoking.
  

Research suggests that perceived susceptibility to illness is an important predictor of preventive health behaviors.

It's difficult to convince people to change a behavior if there isn't something in it for them. People don't want to give up something they enjoy if they don't also get something in return. For example:

• A person probably won't stop smoking if they don't think that doing so will improve their life in some way.
• A couple might not choose to practice safe sex if they don't see how it could make their sex life better. 
• People might not get vaccinated if they do not think there is an individual benefit for them.

These perceived benefits are often linked to other factors, including the perceived effectiveness of a behavior. If you believe that getting regular exercise and eating a healthy diet can prevent heart disease, that belief increases the perceived benefits of those behaviors.

One of the major reasons people don't change their health behaviors is that they think doing so is going to be hard. Changing health behaviors can require effort, money, and time. Commonly perceived barriers include:

• Amount of effort needed
• Danger
• Discomfort
• Expense
• Inconvenience
• Social consequences

Sometimes it's not just a matter of physical difficulty, but social difficulty as well. For example, If everyone from your office goes out drinking on Fridays, it may be very difficult to cut down on your alcohol intake. If you think that condoms are a sign of distrust in a relationship, you may be hesitant to bring them up. 

Perceived barriers to healthy behaviors have been shown to be the single most powerful predictor of whether people are willing to engage in healthy behaviors.

When promoting health-related behaviors such as vaccinations or STD prevention, finding ways to help people overcome perceived barriers is important. Disease prevention programs can often do this by increasing accessibility, reducing costs, or promoting self-efficacy beliefs.

One of the best things about the Health Belief Model is how realistically it frames people's behaviors. It recognizes the fact that sometimes wanting to change a health behavior isn't enough to actually make someone do it.

Because of this, it includes two more elements that are necessary to get an individual to make the leap. These two elements are cues to action and self-efficacy.

Cues to action are external events that prompt a desire to make a health change. They can be anything from a blood pressure van being present at a health fair, to seeing a condom poster on a train, to having a relative die of cancer. A cue to action is something that helps move someone from wanting to make a health change to actually making the change.

Self-efficacy wasn't added to the model until 1988. Self-efficacy looks at a person's belief in their ability to make a health-related change. It may seem trivial, but faith in your ability to do something has an enormous impact on your actual ability to do it.

Finding ways to improve individual self-efficacy can have a positive impact on health-related behaviors. For example, one study found that women who had a greater sense of self-efficacy toward breastfeeding were more likely to nurse their infants longer. The researchers concluded that teaching mothers to be more confident about breastfeeding would improve infant nutrition.

Thinking that you will fail will almost make certain that you do. Self-efficacy has been found to be one of the most important factors in an individual's ability to successfully negotiate condom use.

There are six components of the Health Belief Model. They are perceived severity, perceived susceptibility, perceived benefits, perceived barriers, cues to action, and self-efficacy.

It can be helpful to look at how the Health Belief Model can be applied in different situations. One important aspect of public health is the design of programs that encourage people to engage in healthy behaviors, so understanding how this model can be applied to different situations can be useful.

For example, experts may be interested in understanding public attitudes about cancer screenings. Looking at factors like perceptions of the risk of getting cancer, the benefits of being screened for cancer, and the barriers to being screened can help healthcare professionals look for ways to encourage people to get screened.

The model may also be used for public health programs that are used in different settings. Schools, for example, may rely on educational programs to help children understand challenges regarding health, substance use, physical activity, nutrition, and personal safety. Such programs are often based on the Health Belief Model and work to educate, offer skills training, reduce barriers, and boost self-efficacy.

Healthcare professionals and public health experts can apply the Health Belief Model to create programs and interventions designed to help prevent health problems, encourage treatment behaviors, and support behavior change.

The Health Belief Model has been used for decades to help produce behavior change interventions. Research suggests that the Health Belief Model can be helpful for designing strategies to help promote healthy behaviors and to improve the prevention and treatment of health conditions. 

In a study published in the journal Health Psychology Review, researchers found that in studies looking at the Health Belief Model, 78% reported significant improvement in behavior adherence. Of the studies they looked at, 39% reported moderate to large effects related to health interventions.

The Health Belief Model is not without criticism. Some of the limitations of this approach to understanding health include:

• It does not take into account how people's decisions may be shaped by habitual behaviors. 
• It focuses on the health-related reasons for behaviors but ignores the fact that people often engage in actions for other reasons, such as social acceptance.
• It doesn't address the economic and environmental factors that can affect a person's health behavior. Living in a food desert or lacking the economic resources to afford fresh fruits and vegetables, for example, can be a major barrier to making healthy food choices.
• The model doesn't address the individual beliefs, attitudes, and other characteristics that affect how readily a person can change their behavior.

Critics also suggest that the model focuses on describing health behaviors rather than explaining how to change them. 

Some limitations of the Health Belief Model include it does not adequately address some of the individual factors that affect health behaviors. It also fails to account for how environmental factors, including social variables, impact a person's health choices.

The Health Belief Model can be a helpful way for health educators to design interventions that can improve both individual and public health. By understanding the factors that influence the health choices people make, programs can tackle ways to reduce barriers, improve knowledge, and help people feel more motivated to take action.

It can also be a useful tool for thinking about your own approach to your health. Consider how things such as perceived susceptibility, perceived barriers, self-efficacy, and other elements of the model influence your choices, then look for things that you can do to make healthier choices in your life.

Frequently Asked Questions

• Who developed the Health Belief Model?

  The Health Belief Model was created by social psychologists Irwin M. Rosenstock, Godfrey M. Hochbaum, S. Stephen Kegeles, and Howard Leventhal during the 1950s. It was developed for the U.S. Public Health Services to understand why people fail to engage in healthy behaviors.

• What are the strengths of the Health Belief Model?

  One of the main benefits of the Health Belief Model is that it simplifies health-related constructs so they can be more readily tested and implemented in public health settings. Because it emphasizes some of the prerequisites for health behaviors, it can be helpful for addressing the things that need to happen before a person can successfully implement a behavior change.

• How does the Health Belief Model differ from the Health Promotion Model?

  The Health Promotion Model is a multidimensional approach that takes into account how a person's interaction with their environment affects their health choices. It is similar to the Health Belief Model in some ways, but where the HBM is focused on being health-protective, the Health Promotion Model focuses more on helping people improve their well-being and achieve self-actualization.